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NR 511 Week 3 Assignment: SNAPPS Written Assignment plus SNAPPS ORAL Presentation
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NR 511 Week 3 Assignment: SNAPPS Written Assignment plus SNAPPS ORAL Presentation
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lOMoAR cPSD| 47061011What is the self-directed learning issue that was identified in your oral presentation?
Preventing and treating Urinary Tract infections.
Research the self-directed learning issue and provide a summary of your findings which is fully
supported by appropriate, scholarly, EBM references.
Urinary tract infections (UTIs) are the most common outpatient
infections, with a lifetime incidence of 50−60% in adult women. UTIs are
the most common outpatient infections in the United States (US). With
the exception of a spike in young women aged 14−24 years old, the
prevalence of UTIs increases with age.2 The prevalence in women over 65
years of age is approximately 20%, compared with approximately 11% in
the overall population.3 Between 50% and 60% of adult women will have
at least one UTI in their life, and close to 10% of postmenopausal women
indicate that they had a UTI in the previous year(Medina, M., & Castillo-
Pino, E. (2019)..A urinary tract infection (UTI) is an infection that affects part of the urinary
tract.[1] When it affects the lower urinary tract it is known as a bladder infection (cystitis) and
when it affects the upper urinary tract it is known as a kidney infection (pyelonephritis).
[10] Symptoms from a lower urinary tract infection include pain with urination, frequent urination, and
feeling the need to urinate despite having an empty bladder.[1] Symptoms of a kidney infection
include fever and flank pain usually in addition to the symptoms of a lower UTI.[10] Rarely the urine
may appear bloody.[7] In the very old and the very young, symptoms may be vague or non-specific.
Approximately one in three women suffers an uncomplicated urinary tract infection (UTI) before the
age of 24.[9] The lifetime prevalence of at least one symptomatic UTI in women has been estimated to
be over 50%, with about 26% of women demonstrating a recurrence during six months of follow-up
after treatment of initial UTI.[10] In a study in the primary care setting, 53% of women aged more
than 55 years, and 36% of younger women, reported a recurrence within 1 year.[1]
Recurrent urinary tract infections (UTIs) are defined as two episodes of acute bacterial
cystitis, along with associated symptoms within the last six months or three episodes
within the last year(Aggarwal N et.al 2021)
, lOMoAR cPSD| 47061011
Pathophysiology
Recurrent urinary tract infections are usually new infections with different bacterial
organisms. (If the organism continues to be the same, this is a relapsing infection and
suggests an inadequately treated source such as an abscess, urinary stone, or prostatitis.) The
source of these recurrent infections is the same as for any simple cystitis. Typically, the rectal
bacterial flora contaminates the periurethral area and urethra. From there, bacteria can easily
ascend and reach the bladder. Research demonstrates a complex relationship between the
intestinal, vaginal, and urinary microbiome, which is not well understood.[11]
It is important to differentiate rapid reinfection (a different organism) from a relapse (the
same organism which was not completely treated). A relapse is further defined as a recurrence
within two weeks of completing therapy with the same organism. It is considered reinfection
if the new infection is more than two weeks after completion of therapy even if the organism
is the same. The vast majority of recurrent UTIs typically seen in medical offices and clinics
are reinfections and do not warrant an extensive urological evaluation or imaging. Indications
for imaging include persistent hematuria, history of kidney stones, repeatedly finding Proteus
(often associated with urolithiasis), and relapsing infections. Risk factors for recurrent UTIs
are given listed below. Of these, the most significant include the use of a diaphragm with
spermicide, untreated atrophic vaginitis, and frequent sexual intercourse. Spermicides and
lack of estrogen effect will disrupt the normal vaginal flora, while sexual intercourse tends to
introduce vaginal bacteria into the urethra and bladder.
• Any spermicide use within the previous year, especially if used with a diaphragm
• Atrophic vaginitis
• Chronic diarrhea
• Cystocele
• First UTI when young (prior to 16 years of age)
• Genetic predisposition (usually through bacterial/vaginal mucosal adherence factors)
• Higher frequency of sexual intercourse
• Increased post-void residual urine (incomplete bladder emptying)
• Inadequate fluid intake (low urinary volumes)
• New or multiple sexual partners
• Mother with a history of frequent or multiple UTIs
• Urinary incontinence
• Use of spermicide coated condoms
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